Congenital syphilis, for centuries a leading cause of infant mortality, is often thought of as an antique affliction, relegated to history books — but it is on the rise again. Between 2012 and 2014, there was a spike in congenital syphilis rates, which increased by 38 percent and are now the highest they’ve been in the United States since 2001. As of 2014, the last year for which we have data, more babies were born with syphilis than with HIV.
The word “congenital” simply means that the baby was born with syphilis after being infected in the womb. When an expecting mother has syphilis, the bacteria that cause the disease can cross the placenta to infect the fetus — and will do so 70 percent of the time. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. It can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. Congenital syphilis is especially tragic because it’s almost completely preventable, especially when expecting mothers have access to adequate prenatal care and antibiotics. Penicillin is 98 percent effective in preventing congenital syphilis when it is administered at the appropriate time and at the correct dosage.
More babies are being born with syphilis — but this trend can be reversed with wider access to prenatal care.
Incidence of congenital syphilis is growing across all regions of the country, but rates are highest in the South, followed by the West. Rates have also been increasing across ethnic groups, but, compared to white mothers, congenital syphilis rates are more than 10 times higher among African-American mothers and more than 3 times higher among Latina mothers, illustrating the need to increase access to prenatal care for all expecting mothers — and to ensure that this prenatal care is adequate.
Anyone receiving prenatal care should be screened for syphilis at their first visit, and some pregnant people — including those at increased risk or in areas where congenital syphilis rates are high — should be screened a second time at the beginning of the third trimester and again at delivery.
While 22 percent of mothers giving birth to babies with congenital syphilis in 2014 had no prenatal care, 69 percent of mothers had received prenatal care — but, obviously, the care they received was not sufficient to protect their babies. Most of the mothers receiving prenatal care were either not treated for syphilis, or received inadequate treatment — meaning that they either received treatment too late in their pregnancies, or they received the wrong drug or the wrong dosage. Some mothers weren’t tested for syphilis at all, when screening for syphilis should be a part of anyone’s prenatal care. Other mothers tested negative for syphilis early in their pregnancy, but acquired the infection later in their pregnancy, causing the infection to be missed.
This last point illustrates how important it is to protect the sexual and reproductive health of expecting mothers at all stages of pregnancy. If they are sexually active, their partner can transmit syphilis to them, which in turn can harm their pregnancy. For sexually active people, the best protection against syphilis during pregnancy is to be in a mutually monogamous relationship with a partner who has tested negative for syphilis. If the expecting mother or her partner has multiple sex partners, it is important to use condoms — but, because it can be spread by skin-to-skin contact, condoms don’t offer as much protection against syphilis as they do against other sexually transmitted infections. In this case, regular screening for syphilis can be the difference between life or death for the baby.
The rapid increase in congenital syphilis rates shows that, as a society, we are dropping the ball when it comes to prevention. We need to work toward reducing syphilis rates in women of reproductive age and their sex partners, and we need to be preventing mother-to-child transmission by removing obstacles to prenatal care. If expecting mothers are uninsured or underinsured, they might be burdened with financial difficulties in paying for care. There also might be a limited number of health-care providers in their area who can serve them — for example, expecting mothers on Medicaid might face difficulties in making an appointment if there aren’t enough doctors in the area who accept Medicaid. Expecting mothers who don’t speak English might find it difficult to receive complete, competent health care due to communication barriers. Expecting mothers who do manage to make it to one checkup might not be able to take time off of work or find transportation to return to a clinic for treatment, even in the case that their test results for syphilis come back positive.
Congenital syphilis can be prevented at many levels, starting with comprehensive sex education in the schools, continuing with access to condoms and STD screening and treatment, and ending with competent, adequate prenatal care at every stage of pregnancy. If you are concerned that you are at risk for syphilis, you can get tested at a Planned Parenthood health center, as well as other clinics, private health-care providers, and health departments. You can also drop by to ask questions about safer sex or to pick up condoms. Some Planned Parenthood health centers offer prenatal care, while others offer referrals to local resources.
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